title: Nursing and midwifery regulatory reform in east, central, and southern Africa: a survey of key stakeholders.
abstract: BACKGROUND
  In sub-Saharan Africa, nurses and midwives provide expanded HIV services previously seen as the sole purview of physicians. Delegation of these functions often occurs informally by shifting or sharing of tasks and responsibilities. Normalizing these arrangements through regulatory and educational reform is crucial for the attainment of global health goals and the protection of practitioners and those whom they serve. Enacting appropriate changes in both regulation and education requires engagement of national regulatory bodies, but also key stakeholders such as government chief nursing officers (CNO), professional associations, and educators. The purpose of this research is to describe the perspectives and engagement of these stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA).
  
  
  METHODS
  We surveyed individuals from these three stakeholder groups with regard to task shifting and the challenges related to practice and education regulation reform. The survey used a convenience sample of nursing and midwifery leaders from countries in ECSA who convened on 28 February 2011, for a meeting of the African Health Profession Regulatory Collaborative.
  
  
  RESULTS
  A total of 32 stakeholders from 13 ECSA countries participated in the survey. The majority (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. Stakeholders also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change.
  
  
  CONCLUSIONS
  While guidelines on task shifting and recommendations on transforming health professional education exist, this study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as CNOs, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation.
  
  
  CONCLUSIONS
  This study provides information for effectively engaging leaders in regulatory reform by clarifying their roles, responsibilities, and activities regarding regulation overall as well as their specific perspectives on task shifting and pre-service reform.
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U,S, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS-E30, Atlanta, GA, 30333, USA. cmccarthy@cdc.gov.
authors.forename: Carey F
authors.initials: CF
authors.lastname: McCarthy
authors.forename: Joachim
authors.initials: J
authors.lastname: Voss
authors.forename: Marla E
authors.initials: ME
authors.lastname: Salmon
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Gross
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Kelley
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Riley